Background: Postpartum hemorrhage (PPH) is the single largest and leading cause of maternal morbidity and mortality not only in developing countries but also in developed countries. Therefore, reducing blood loss during cesarean delivery (C/d) is essential and challenging for anesthesiologists and obstetricians. This study aimed to see how tranexamic acid (Txa), oxytocin (Ox), and carboprost tromethamine (Cpt) work compared to ethamsylate (Eth) and oxytocin (Ox) in women who had a high risk of getting PPH and were having elective lower-segment C/d. Materials and Methods: A single-center, parallel, prospective, double-blind, randomized, and clinical comparative study was conducted after obtaining institutional ethical approval. The study involved 264 females (age range, 18–45 years) at high risk for PPH undergoing elective C/d at 35–40 weeks gestation between December 2022 and November 2023. Participants in the Txa+Ox+Cpt group received an infusion of Txa 1g before the skin incision, an infusion of oxytocin 20 units diluted in 500 ml of Ringer’s solution, and a myometrial injection of 0.25 mg/1 ml Cpt immediately following the C/d of the infant. In the Eth+Ox group, patients received an infusion of Eth 1g before the skin incision, an infusion of 20 units oxytocin diluted in 500 ml of Ringer’s solution started, and a myometrial injection of Nacl 0.9%/1ml (a placebo) immediately following the C/d of the infant. The primary outcome was the blood loss calculation, alongside hemoglobin and hematocrit before and after the surgery. The secondary outcome was the percentage of participants who progressed into primary PPH and required blood transfusion. Results: Our study included 132 gravid women in each group and showed that in the Txa+Ox+Cpt and Eth+Ox groups, postoperative blood loss was 417.8 ± 93.60 and 602.5 ± 122.8 ml, respectively, P < 0.001. The duration of surgery in the Txa+Ox+Cpt group was less than in the Eth+Ox group but statistically insignificant ( P = 0.286). The blood transfusion requirement in the Txa+Ox+Cpt and Eth+Ox groups was 3.03% and 9.23%, respectively ( P = 0.031). The PPH in the Txa+Ox+Cpt and Eth+Ox groups were 8.33% and 24.6%, respectively ( P < 0.016). In the Txa+Ox+Cpt and Eth+Ox groups, the pre-and postoperative (at 24 hrs after C/d) hemoglobin and hematocrit values were (11.13 and 10.01), (10.98 and 8.41) g/dl and (33.20 and 30.07), (32.91 and 25.19) %, respectively ( P < 0.05). Conclusion: The combination of tranexamic acid, oxytocin, and carboprost tromethamine was more effective than the ethamsylate and oxytocin group in preventing PPH in high-risk patients undergoing cesarean delivery.
Singh et al. (Tue,) studied this question.